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NAVY AND MARINE CORPS MEDICAL NEWS
MN-00-46
NOVEMBER 17, 2000

	NAVY AND MARINE CORPS MEDICAL NEWS (MEDNEWS) IS A WEEKLY 
COMPENDIUM OF NEWS AND INFORMATION CONTRIBUTED BY COMMANDS 
THROUGHOUT THE NAVY MEDICAL DEPARTMENT. INFORMATION CONTAINED IN 
MEDNEWS STORIES IS NOT NECESSARILY ENDORSED BY NAVY BUREAU OF 
MEDICINE AND SURGERY (BUMED), NOR SHOULD IT BE CONSIDERED 
OFFICIAL NAVY POLICY.
	BUMED DISTRIBUTES MEDNEWS TO SAILORS AND MARINES, THEIR 
FAMILIES, CIVILIAN EMPLOYEES AND RETIRED NAVY AND MARINE CORPS 
FAMILIES. FURTHER DISTRIBUTION IS HIGHLY ENCOURAGED.
	STORIES IN MEDNEWS USE THESE ABBREVIATIONS AFTER A NAVY 
MEDICAL PROFESSIONAL'S NAME TO SHOW AFFILIATION: MC - MEDICAL 
CORPS (PHYSICIAN); DC - DENTAL CORPS; NC - NURSE CORPS; MSC - 
MEDICAL SERVICE CORPS (CLINICIANS, RESEARCHERS AND 
ADMINISTRATIVE MANAGERS). HOSPITAL CORPSMEN (HM) AND DENTAL 
TECHNICIAN (DT) DESIGNATORS ARE PLACED IN FRONT OF THEIR NAMES.

CONTENTS FOR THIS WEEK'S MEDNEWS:
- NEONATAL INTENSIVE CARE UNIT PROVIDES SUPPORT IN WESTERN 
PACIFIC 
- BENEFICIARIES CAN HELP AVOID MEDICAL BILL PROBLEMS
- CYBER LIBRARIES ENHANCE MILITARY HEALTH CARE
- LET'S HEAR IT FOR EAR PROTECTION
- TRICARE RECOGNIZES EMPLOYEE EXCELLENCE
- TRICARE QUESTION AND ANSWER
- HEALTHWATCH: TINY INVADERS CAN SPOIL HOLIDAY FEAST

6.  STORIES

HEADLINE: NEONATAL INTENSIVE CARE UNIT PROVIDES SUPPORT IN 
WESTERN PACIFIC
FROM USNH OKINAWA
	OKINAWA - THE HOPES OF CHRISTOPHER AND ROSEANNE KRONSHAGEN 
HUNG IN THE BALANCE AS THEIR 5-DAY OLD DAUGHTER ALEXIS WAS 
PLACED ONTO A HEART-LUNG BYPASS IN A EXTRAORDINARY ATTEMPT TO 
SAVE HER LIFE. 
	BUT HER LONG ROAD TO RECOVERY WAS ONLY AT THE BEGINNING AS 
DOCTORS AND NURSES FROM THE NEONATAL INTENSIVE CARE UNIT (NICU) 
OF U.S. NAVAL HOSPITAL OKINAWA PREPARED FOR WHAT WOULD BE A 
HISTORY-MAKING AIRLIFT - THE LONGEST TRANSPORT OF A PATIENT ON A 
HEART-LUNG BYPASS MACHINE.
	BEFORE ALEXIS WAS BORN, ROSEANNA HAD BEEN ADVISED THAT HER 
AMNIOTIC FLUID CONTAINED MECONIUM, OR FETAL FECES. OF THE MANY 
BABIES BORN EVERY YEAR WITH THIS CONDITION, ONLY A SMALL NUMBER 
OF THEM DEVELOP MECONIUM ASPIRATION SYNDROME, WHICH OCCURS WHEN 
THE BABY BREATHES THE FECES INTO HER LUNGS. ALEXIS WAS ONE OF 
THE UNLUCKY FEW.
	MOMENTS AFTER SHE WAS BORN, HER PARENTS WATCHED AS SHE WAS 
RUSHED TO THE NICU WHERE DOCTORS PUT HER ON A VENTILATOR AND 
WORKED TO REVERSE THE DAMAGE TO HER LUNGS CAUSED BY THE 
MECONIUM. 
	"IN THE VAST MAJORITY OF CASES OF MECONIUM ASPIRATION WE 
ARE ABLE TO SUPPORT THE INFANT THROUGH TO RECOVERY," SAID DR. 
PETER GRUBB, ONE OF THE TWO NEONATOLOGISTS WHO TOOK CARE OF 
ALEXIS. "IN HER CASE, WE WERE ABLE TO STABILIZE HER; HOWEVER THE 
SEVERITY OF HER LUNG INJURY WAS BEGINNING TO CAUSE HER HEART TO 
FAIL."
	WITHOUT PROPER TREATMENT, HER CHANCES OF SURVIVAL WERE 
ABOUT 10 PERCENT AND DROPPING, SAID DR. DANIEL DIRNBERGER, THE 
ATTENDING NEONATOLOGIST. ACCORDING TO DIRNBERGER, EXTRACORPOREAL 
MEMBRANE OXYGENATION, OR ECMO, IS A HEART-LUNG BYPASS PROCESS 
THAT ALLOWS THE HEART AND LUNGS TO RELAX AND RECOVER FROM 
INJURY.
	THE ONLY WAY TO GET HER TO AN ECMO CENTER WAS TO PLACE HER 
ON ECMO IN OKINAWA AND TRANSPORT HER ON BYPASS. THE ONLY CENTER 
IN THE WORLD WITH THE EXPERIENCE AND EQUIPMENT TO ATTEMPT A 
TRANS-PACIFIC ECMO TRANSPORT IS WILFORD HALL MEDICAL CENTER, IN 
SAN ANTONIO, TX. 
	"ALEXIS WAS UNIQUELY FORTUNATE TO BE BORN HERE AT USNHO, 
THE WESTPAC REFERRAL CENTER FOR CRITICALLY-ILL NEWBORNS, 
ESPECIALLY CONSIDERING THE COMBINED ECMO EXPERIENCE WE HAVE 
HERE. WE WERE ABLE TO ANTICIPATE THE SUPPLIES, BLOOD PRODUCTS, 
AND SUPPORT THE TRANSPORT TEAM WOULD REQUIRE," SAID DIRNBERGER.
	THE 15-PERSON TRANSPORT TEAM ROLLED INTO THE NICU, AND 
WITHIN A FEW HOURS, ALEXIS'S HEART AND LUNGS BEGAN TO RELAX AS 
THE BYPASS CIRCUIT TOOK OVER. ONCE SHE STABILIZED ON THE 
CIRCUIT, THE TEAM DEPARTED ON A MEDICALLY AND LOGISTICALLY 
COMPLICATED AIRLIFT MISSION.
	ORCHESTRATED FROM THE TANKER AIRLIFT CONTROL CENTER, SCOTT 
AFB, ILL, THE MISSION WAS SUPPORTED BY DOZENS OF AIRLIFTERS, 
MEDICAL SPECIALISTS, AND THREE AIRCRAFT. 
	A C-9 NIGHTINGALE CARRIED THEM THE 900 MILES TO YOKOTA AB, 
JAPAN, WHERE A C-17 GLOBEMASTER III WAS WAITING TO CARRY THEM 
THE REMAINING 5700 MILES TO KELLY AFB, SAN ANTONIO. BECAUSE 
EVERY LANDING AND TAKE-OFF INCREASES THE RISKS OF COMPLICATIONS 
WITH A PATIENT ON BYPASS, THE AIRLIFT INCLUDED A DELICATE MIDAIR 
REFUELING ON THE 14-HOUR LEG TO SAN ANTONIO. 
	ALEXIS RESPONDED WELL TO ECMO, AND WAS TAKEN OFF BYPASS 
SUPPORT WITHIN SEVEN DAYS. ACCORDING TO DIRNBERGER, SHE 
RECOVERED QUICKLY THEREAFTER. SHE IS CURRENTLY BACK IN OKINAWA 
WITH HER FAMILY, AND IS A HEALTHY CHILD WITH NO APPARENT 
RESIDUAL LUNG DISEASE.
	"THEY TELL YOU IN BRIEFINGS ABOUT YOUR MEDICAL BENEFITS IN 
THE MILITARY, BUT ONLY WHEN SOMETHING LIKE THIS HAPPENS, AND 
YOUR DAUGHTER'S LIFE IS SAVED, DO YOU REALLY APPRECIATE WHAT YOU 
HAVE," SAYS SGT. KRONSHAGEN.
					-USN-

HEADLINE: BENEFICIARIES CAN HELP AVOID MEDICAL BILL PROBLEMS
FROM AMERICAN FORCES PRESS SERVICE
	WASHINGTON - THERE ARE SEVERAL STEPS TRICARE BENEFICIARIES 
CAN TAKE TO AVOID GETTING IN HOT WATER OVER UNPAID MEDICAL 
BILLS, MILITARY HEALTH CARE OFFICIALS SAID.
	TRICARE OFFICIALS HAVE LEARNED SEVERAL LESSONS SINCE 
IMPLEMENTING THE DEBT COLLECTION ASSISTANCE OFFICER PROGRAM, 
JULY 26. THE PROGRAM IS DESIGNED TO HELP BENEFICIARIES DEAL WITH 
UNPAID MEDICAL BILLS THAT HAVE BEEN SENT TO A COLLECTION AGENT 
OR A CREDIT BUREAU.
	THE BENEFICIARY SHOULD FIRST MAKE SURE INFORMATION ON THE 
TRICARE EXPLANATION OF BENEFITS NOTIFICATION IS CORRECT.
	"IT'S EASY FOR MISTAKES TO OCCUR WHEN PEOPLE ARE CODING IN 
NUMBERS AND LETTERS," SAID MARCIA BONIFAS, TRICARE MANAGEMENT 
ACTIVITY'S DIRECTOR OF CUSTOMER SERVICE AND BENEFICIARY 
EDUCATION. "IF A SOCIAL SECURITY NUMBER OR PROCEDURE CODE IS ONE 
NUMBER OFF, IT CAN RESULT IN A CLAIM DENIAL."
	"THIS CAN BE RESOLVED MUCH MORE QUICKLY IF THE BENEFICIARY 
NOTICES THE PROBLEM AND IMMEDIATELY CALLS THE CLAIMS PROCESSOR," 
SHE SAID.
	BENEFICIARIES SHOULD ALSO MAKE BETTER USE OF BENEFICIARY 
COUNSELING AND ASSISTANCE COORDINATORS AT EACH MILITARY MEDICAL 
TREATMENT FACILITY. "WHEN BENEFICIARIES RECEIVE A DUNNING 
NOTICE, A NOTICE THAT THE BILL HAS NOT YET GONE TO A COLLECTION 
AGENCY BUT IT WILL IF NOT PAID WITHIN 30 DAYS, THE COORDINATORS 
WILL TAKE THAT ON AND WORK WITH THE CLAIMS PROCESSOR TO GET IT 
PAID," BONIFAS SAID.
	THIS ADVICE ALSO APPLIES TO ANY BILL BENEFICIARIES DON'T 
UNDERSTAND. "IF YOU GET A BILL AND YOU'RE NOT SURE WHAT IT IS, 
GET IT IN TO YOUR TRICARE SERVICE CENTER AND GET THEM ENGAGED 
EARLY," AIR FORCE COL. FRANK CUMBERLAND, THE AGENCY'S DIRECTOR 
OF COMMUNICATIONS, SAID. "INDIVIDUALS SHOULD IDENTIFY PROBLEMS 
AS EARLY AS THEY SENSE THEM. WE WANT TO SOLVE PROBLEMS AS EARLY 
IN THE PROCESS AS POSSIBLE."
	SINCE THE PROGRAM BEGAN, BONIFAS NOTED, BENEFICIARIES HAVE 
MADE GOOD USE OF THE INTERNET TO GET CORRECT INFORMATION ABOUT 
THE DEBT COLLECTION PROGRAM. "THEY SEE IT ON THE FRONT PAGE [OF 
THE TRICARE HOME PAGE] AND KNOW EXACTLY WHERE THEY NEED TO GO IF 
THEY GET SOME SORT OF NOTIFICATION OR HAVE A QUESTION," SHE 
SAID.
	ABOUT 300 CLAIMS HAVE BEEN BROUGHT TO THE DEBT COLLECTION 
ASSISTANCE OFFICERS, AND OFFICIALS SAY HALF OF THEM HAVE BEEN 
RESOLVED ALREADY. "OUR GOAL IS TO GET EACH CLAIM SETTLED WITHIN 
30 DAYS OF OUR FINDING OUT ABOUT IT," BONIFAS SAID.
					-USN-

HEADLINE: CYBER LIBRARIES ENHANCE MILITARY HEALTH CARE
BY GERRY J. GILMORE, AMERICAN FORCES PRESS SERVICE
	WASHINGTON - ONE DAY SOON, ALL MILITARY HEALTH CARE 
PROVIDERS WHETHER IN THE PENTAGON OR DOD'S MOST REMOTE OUTPOST 
WILL BE JUST A COMPUTER SCREEN AWAY FROM A COMPLETE, 
AUTHORITATIVE MEDICAL LIBRARY.
	"DOD'S HEALTH CARE ORGANIZATION IS ONE OF THE LARGEST WITH 
8 MILLION BENEFICIARIES AND 500 MEDICAL TREATMENT FACILITIES 
WORLDWIDE. THE CARE PROVIDED SERVICE MEMBERS AND THEIR FAMILIES 
AFFECTS READINESS AND QUALITY OF LIFE," SAID ARMY DR. (LT. COL.) 
WILLIAM L. LANG. "ONLINE MEDICAL INFORMATION SERVICES REPRESENT 
A LEAP IN TECHNOLOGY THAT ENHANCES BOTH CONCERNS."
	FOR INSTANCE, HE SAID, ONLINE LIBRARY ACCESS COULD BE A 
VALUABLE AID TO MILITARY HEALTH CARE PRACTITIONERS AT REMOTE 
POSTS OR IN FIELD LOCATIONS. READING THE LATEST MEDICAL TEXTS 
AND ARTICLES IS A GOOD WAY TO KEEP UP WITH CHANGING TECHNOLOGY, 
HE ADDED, WHILE ONLINE SERVICES CAN BE USED IN PLACES THAT HAVE 
NO LIBRARIES.
	MOST MILITARY MEDICAL TREATMENT FACILITIES ARE GOING TO 
HAVE SOME DEGREE OF ACCESS TO THE INTERNET AND AVAILABLE ONLINE 
MEDICAL INFORMATION LIBRARIES, SAID LANG, A FAMILY PRACTICE 
PHYSICIAN IN THE DIRECTORATE OF INFORMATION MANAGEMENT AT THE 
TRICARE MANAGEMENT ACTIVITY IN FALLS CHURCH, VA.
	OVER THE LAST YEAR, HE SAID, VARIOUS INDIVIDUAL ARMY, NAVY 
AND AIR FORCE MEDICAL ORGANIZATIONS HAVE CONTRACTED FOR ACCESS 
TO MEDICAL INFORMATION ON INTERNET SITES. DEPENDING ON HOW THE 
CONTRACTS ARE WRITTEN, "YOU CAN ALSO ACCESS THE ONLINE MEDICAL 
LIBRARY AWAY FROM THE MILITARY TREATMENT FACILITIES."
	"LET'S SAY YOU HAVE A PHYSICIAN'S ASSISTANT WORKING IN AN 
INFANTRY BATTALION. AS LONG AS HE CAN GET TO A COMPUTER WITH 
INTERNET ACCESS, HE CAN OBTAIN THE MEDICAL INFORMATION NEEDED BY 
USING THE APPROPRIATE PASSWORD. HE CAN EXPAND HIS KNOWLEDGE BASE 
AND BE A MORE EFFECTIVE PROVIDER," SAID LANG.
	HE SAID THE IDEA OF INTERNET MEDICAL LIBRARIES HAS 
PERCOLATED IN DOD'S MEDICAL COMMUNITY FOR THE PAST FOUR OR FIVE 
YEARS. HE WAS INVOLVED IN AN INFORMAL GROUP THAT RESEARCHED THE 
FEASIBILITY OF A DOD-WIDE SYSTEM OF CONTRACTED ONLINE MEDICAL 
INFORMATION SERVICES.
	ALSO OVER THE LAST YEAR, THE ARMY, NAVY AND AIR FORCE 
SURGEONS GENERAL ASKED THE MEDICAL LIBRARY COMMUNITIES, TOGETHER 
WITH THE UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES 
(USUHS), TO LOOK INTO ESTABLISHING  "LIBRARIES OF THE FUTURE," 
WHICH MEANT ACCESS BY THE INTERNET OR OTHER ELECTRONIC MEANS, 
LANG SAID.
	FOR NOW, HOWEVER, "WE RECEIVED NO SIGNIFICANT FINANCIAL 
BENEFIT BY GOING TO A JOINT-SERVICE PURCHASE," LANG NOTED.  
BECAUSE OF THAT, THE SERVICES HAVE NEGOTIATED THEIR OWN INTERNET 
MEDICAL LIBRARY CONTRACTS.
	THE MEDICAL INFORMATION COMPILED BY THE VARIOUS INTERNET 
LIBRARY COMPANIES IS EXTREMELY VALUABLE, BUT EXPENSIVE AND TIME-
CONSUMING TO MAINTAIN AND KEEP CURRENT, HE SAID.
	"SPECIFIC METHODS OF ACCESSING THE INFORMATION MAY VARY 
FROM SERVICE TO SERVICE. THE COMPANIES WE'VE BEEN WORKING WITH 
HAVE BEEN VERY GOOD AT COMING UP WITH ACCESS APPROACHES THAT ARE 
REASONABLE TO CONTROL," LANG SAID.
	FRANK J. BECKER, AN INTERNET LIBRARY PROJECT MANAGER AT 
THE NAVAL MEDICAL INFORMATION MANAGEMENT CENTER, BETHESDA, NOTES 
THAT INTERNET-BASED DELIVERY OF MEDICAL RESOURCES WITHIN THE 
NAVY IS STILL PRIMARILY LIMITED TO SHORE ORGANIZATIONS AND SHIPS 
IN PORT. HE BELIEVES THE SITUATION WILL IMPROVE NOW THAT THE 
NAVY AND MARINE
CORPS HAVE ANNOUNCED PLANS FOR AN INTEGRATED COMPUTER SYSTEM IN 
THE NEXT FEW YEARS THAT WILL LINK EVERY SAILOR AND MARINE NO 
MATTER WHERE THEY ARE.
	WHILE SHIPS CONTINUE TO IMPROVE THEIR COMPUTER 
CONNECTIVITY, HE ADDED, THE NAVY BOUGHT CD-ROM LIBRARIES THAT 
MEDICAL STAFFS CAN USE WHILE AT SEA. LANG HASN'T GIVEN UP HOPE 
FOR A DOD-WIDE INTERNET MEDICAL LIBRARY SYSTEM. "BUT FOR NOW, 
THE COST-BENEFIT IS DOING IT AT THE SERVICE LEVEL," HE SAID.
					-USN-

HEADLINE: LET'S HEAR IT FOR EAR PROTECTION
BY JO3 PAUL NEWELL, USS GEORGE WASHINGTON
	USS GEORGE WASHINGTON - YOU CAN'T ESCAPE IT. THE DEAFENING 
SCREAM OF A JET ENGINE OR THE CONSTANT RAT-A-TATS OF A NEEDLE 
GUN - LOUD AND ANNOYING NOISES ARE EVERYWHERE ON USS GEORGE 
WASHINGTON (CVN 73).
	EVEN SAILORS WHO DON'T WORK IN A SPACE WITH LOUD EQUIPMENT 
PROBABLY WORK NEAR ONE. SOME MAY SAY THEY'RE GETTING USED TO THE 
EVERYDAY NOISE ASSOCIATED WITH LIFE AT SEA ON A CARRIER, SK1 TOM 
O'NEIL, ONE OF TWO HEARING PROTECTION MONITORS ABOARD GEORGE 
WASHINGTON, SAID THE ONLY THING HE WANTS HIS SAILORS TO GET USED 
TO IS SAFEGUARDING THEIR EARS.
	"THE MOST FRUSTRATING THING IS SEEING PEOPLE CONSTANTLY 
DISREGARD THE NEED FOR HEARING PROTECTION," SAID O'NEIL. "IT 
JUST DOESN'T SEEM LIKE THEY KNOW WHAT THEY ARE BEING EXPOSED TO. 
IF THEY KNEW, THEY MIGHT WEAR HEARING PROTECTION ALL THE TIME.
	CMDR. BOB LUCAS IS TRYING TO MAKE SOME NOISE OF HIS OWN. 
HIS MOTIVATION FOR REDUCING NOISE ABOARD GEORGE WASHINGTON COMES 
FROM YEARS OF ABUSING HIS HEARING WHILE FLYING HELICOPTERS. IN 
FACT, HE HAS LOGGED OVER 4,000 HOURS OF FLIGHT TIME SINCE 1981, 
SOMETHING HE'S PAYING THE PRICE FOR TODAY.
	"I HAVE 65 PERCENT HEARING LOSS IN MY LEFT EAR, AND 45 
PERCENT IN THE OTHER FROM YEARS OF FLYING," SAID LUCAS. "IT'S 
TOO LATE FOR ME TO BE HEALED."
	BUT FOR OTHERS, IT'S NOT TOO LATE. RECENTLY, THE NAVY 
COMMITTED $13 MILLION TO INVESTIGATE THE POTENTIAL REDUCTION OF 
NOISE ABOARD ITS SHIPS. DURING THE YARD PERIOD, THE GEORGE 
WASHINGTON IS SCHEDULED TO INSTALL MOUNTED ORIFICES WITH JET 
BLAST DEFLECTORS. THEY SHOULD GREATLY REDUCE THE INCREDIBLY LOUD 
SOUND ON THE FLIGHT DECK. 
	"AFTER STAYING IN A NOISY AREA LONG ENOUGH, THE EAR'S 
NERVES WILL BE AFFECTED. GOING TO AN OCCASIONAL ROCK CONCERT, OR 
CRANKING UP THE RADIO IS FINE ONCE IN A WHILE, BUT CONSTANT 
EXPOSURE WILL HARM OUR ABILITY TO HEAR," SAYS GEORGE 
WASHINGTON'S PHYSICIAN ASSISTANT, LT. ROGER TALBOT. "IT'S A 
GRADUAL PROGRESSION AND WE REALLY NEED TO BE AWARE OF THE 
EFFECTS OF WORKING IN SPACES WHERE SOUND GENERATES HEAVY NOISE."
	THAT'S ESPECIALLY TRUE FOR FLIGHT DECK SAILORS.  FOR HOURS 
EACH DAY, THEY ARE EXPOSED TO SOUND LEVELS THAT CAN REACH OVER 
THE 130 DECIBEL RANGE. ACCORDING TO GEORGE WASHINGTON'S 
INDUSTRIAL HYGIENE OFFICER, LT. MIKE LUTTE, THAT'S ENOUGH TO 
MAKE YOUR EARDRUMS BLEED.
	BESIDES USING THE COMMON YELLOW EARPLUG, THESE SAILORS ARE 
ALSO REQUIRED TO WEAR MICKEY MOUSE EARS. "WITH ONLY ONE FORM OF 
EAR PROTECTION, FLIGHT DECK SAILORS WOULD SUFFER SOME SERIOUS 
HEARING LOSS AFTER A WHILE," SAID LUTTE SAID. "THAT'S WHY THEY 
NEED DOUBLE HEARING [PROTECTION]."
	WHILE LONG-TERM SOLUTIONS TO SOME OF THE BIGGER NOISE 
PROBLEMS ARE BEING WORKED OUT, O'NEIL SAID THE SAFETY DEPARTMENT 
IS WILLING TO DO WHAT THEY CAN TO ASSURE SAILORS GET THE HEARING 
PROTECTION THEY NEED.
	"WE'RE ALWAYS WILLING TO TEACH OUR SHIPMATES ABOUT HEARING 
PROTECTION OR TO GIVE OUT EAR PLUGS TO SAILORS IN NEED," SAID 
O'NEIL. "IF THEIR DIVISION OR DEPARTMENT DOESN'T HAVE THE MONEY 
IN THEIR FUNDS, WE'LL HELP OUT. IT'S THE KIND OF INVESTMENT WE 
LIKE MAKING."
					-USN-

HEADLINE: TRICARE RECOGNIZES EMPLOYEE EXCELLENCE
BY STAFF SGT. KATHLEEN T. RHEM, AMERICAN FORCES PRESS SERVICE
	WASHINGTON - TRICARE OFFICIALS ARE WORKING TO HIGHLIGHT 
THEIR PROGRAM BY GIVING A HIGH-PROFILE PAT ON THE BACK TO THOSE 
WHO GO "ABOVE AND BEYOND" TO MAKE TRICARE A SUCCESS.
	"WE WERE KIND OF FORGETTING ONE ABSOLUTELY VITAL GROUP AND 
THAT IS THE PEOPLE IN THE TRENCHES WHO DELIVER TRICARE EVERY DAY 
-- THE PEOPLE WHO BOOK THE APPOINTMENTS, SET UP THE REFERRALS 
AND HELP WITH CLAIMS, THE HEALTH BENEFITS ADVISERS, THE TRICARE 
SUPPORT CENTER PERSONNEL," SAID AIR FORCE COL. FRANK CUMBERLAND, 
TRICARE'S DIRECTOR OF COMMUNICATIONS AND CUSTOMER SERVICE.
	AS A RESULT, HE SAID, OFFICIALS STARTED "HEROES OF 
TRICARE," A MONTHLY RECOGNITION PROGRAM THAT HONORS AN 
OUTSTANDING PERSON, OFFICE, FACILITY OR ORGANIZATION FOR THEIR 
ACHIEVEMENTS IN HELPING BENEFICIARIES LEARN ABOUT AND 
SUCCESSFULLY USE TRICARE AND THE MILITARY HEALTH SYSTEM.
	SINCE THE PROGRAM'S INCEPTION IN JUNE, TRICARE HAS 
RECOGNIZED THREE HEROES FOR THEIR EXCELLENCE IN CLAIMS WORK, 
IMPROVEMENTS TO TRICARE AND PATIENT ACCESS. FUTURE SALUTES WILL 
FOCUS ON IMPROVING BUSINESS PROCESSES, COMMUNICATIONS AND 
OPTIMIZATION, AMONG OTHER AREAS.
	HONOREES RECEIVE A LETTER FROM TRICARE MANAGEMENT AGENCY 
DIRECTOR DR. JAMES SEARS AND RECOGNITION ON THE AGENCY'S 
INTERNET HOME PAGE AT WWW.TRICARE.OSD.MIL. 
	POSTERS HIGHLIGHTING THE RECOGNITION GO UP AT RECIPIENT'S 
WORKPLACES AND IN A HALL OF HEROES AT AGENCY HEADQUARTERS HERE, 
AND THEY WILL BE DISPLAYED AT THE ANNUAL DOD TRICARE CONFERENCE 
IN JANUARY. TRICARE OFFICIALS WILL ALSO SHARE THE RECOGNITION 
WITH EACH RECIPIENT'S SERVICE SURGEON GENERAL.
	"MAYBE IT'S NOT A MILLION DOLLARS AND MAYBE IT'S NOT AN 
IMMEDIATE PROMOTION, BUT IT ANNOUNCES TO YOUR PEERS, YOUR 
CUSTOMERS AND YOUR LEADERSHIP THAT YOU'RE THERE DOING THE JOB 
DAY TO DAY IN AN OUTSTANDING MANNER," CUMBERLAND SAID.
	CUMBERLAND ALSO SAID HE HOPES THE PROGRAM "PUTS A FACE ON 
TRICARE" IN THE MINDS OF BENEFICIARIES. "IT'S EASY FOR PEOPLE TO 
THINK OF TRICARE AS A PROGRAM OR A BENEFIT OR A CONTRACTOR, BUT 
YOU HAVE TO REMEMBER THAT, JUST LIKE EVERYTHING ELSE WE DO IN 
THE DEPARTMENT OF DEFENSE, IT REALLY IS PEOPLE THAT ARE OUT 
THERE DELIVERING THE GOODS," HE SAID.
					-USN-

HEADLINE: TRICARE QUESTION AND ANSWER
	QUESTION: IS PREVENTIVE CARE COVERED UNDER STANDARD OR 
EXTRA? 
	ANSWER: PREVENTIVE CARE IS AN ADDED BENEFIT UNDER PRIME. 
IF THE PARTICULAR PREVENTIVE SERVICE IS A BENEFIT INCLUDED UNDER 
THE TRICARE STANDARD (CHAMPUS) BENEFITS, YOU WILL BE RESPONSIBLE 
FOR THE DEDUCTIBLE AND COPAYMENT UNDER EXTRA AND STANDARD. SEE 
YOUR HEALTH BENEFITS REPRESENTATIVE 
					-USN-

HEADLINE: HEALTHWATCH: TINY INVADERS CAN SPOIL HOLIDAY FEAST
BY STAFF SGT. KATHLEEN T. RHEM, AMERICAN FORCES PRESS SERVICE
	WASHINGTON - PICTURE IT, THE PERFECT THANKSGIVING. YOU'VE 
EATEN YOUR FILL; THE DISHES ARE DONE; FOOTBALL IS ON THE TUBE.
	THEN JUST AS YOU ARE STARTING TO THINK ABOUT A TURKEY 
SANDWICH -- IT STRIKES. YOU FEEL A RUMBLING DEEP IN YOUR BELLY, 
MAYBE A LITTLE QUEASINESS. NEXT THING YOU KNOW, YOU'RE RUNNING 
FOR THE BATHROOM. CHANCES ARE YOU'VE JUST FALLEN VICTIM TO A 
TINY INVADER -- ANY ONE OF 250 DIFFERENT BACTERIA THAT CAN 
INHABIT FOOD AND CAUSE ILLNESS IF THE FOOD'S NOT HANDLED 
PROPERLY.
	ATLANTA'S CENTERS FOR DISEASE CONTROL AND PREVENTION 
ESTIMATE FOOD-BORNE ILLNESSES STRIKE 76 MILLION PEOPLE EACH 
YEAR. MORE THAN 300,000 ARE HOSPITALIZED AND 5,000 DIE.
	FOOD-BORNE ILLNESSES CAN SICKEN ANYONE, BUT INFANTS, THE 
ELDERLY AND THOSE WITH COMPROMISED IMMUNE SYSTEMS ARE AT 
GREATEST RISK, ACCORDING TO CARLLA E. JONES, A HEALTH PROMOTION 
PROGRAM ANALYST WITH THE ARMY'S CENTER FOR HEALTH PROMOTION AND 
PREVENTIVE MEDICINE AT FORT DETRICK, MD.
	THE TWO MOST COMMON SYMPTOMS ARE VOMITING AND DIARRHEA, 
JONES SAID. STOMACH CRAMPS, FEVER, MUSCLE PAIN AND HEADACHES ARE 
ALSO POSSIBLE.
	ILLNESS-CAUSING BACTERIA THRIVE IN CERTAIN ENVIRONMENTS, 
PARTICULARLY MOIST SURFACES BETWEEN 40 AND 140 DEGREES 
FAHRENHEIT, JONES SAID. SHE SAID BACTERIA BREEDS IN RAW OR 
PROCESSED MEAT, POULTRY AND SEAFOOD, AND DAIRY AND EGG PRODUCTS.
	"KEEP IN MIND, HOWEVER, THAT EVEN SAFE, READY-TO-EAT FOODS 
CAN BECOME CROSS CONTAMINATED WITH BACTERIA TRANSFERRED FROM RAW 
FOOD PRODUCTS, MEAT JUICES, FOOD PREPARATION EQUIPMENT OR AS A 
RESULT OF POOR PERSONAL HYGIENE," JONES SAID.
	SHE SHARED THE FOLLOWING TIPS FOR PREVENTING FOOD-BORNE 
ILLNESSES.
	- WASH HANDS AND SURFACES OFTEN. WASH HANDS IN HOT SOAPY 
WATER BEFORE PREPARING FOOD AND AFTER USING THE BATHROOM, 
CHANGING DIAPERS AND HANDLING PETS.
	- WASH CUTTING BOARDS, UTENSILS AND COUNTER TOPS IN HOT 
SOAPY WATER AFTER PREPARING EACH FOOD ITEM AND BEFORE GOING ON 
TO THE NEXT ONE.
	- WASH DISHTOWELS OFTEN IN THE HOT CYCLE OF THE WASHING 
MACHINE.
	- DON'T CROSS-CONTAMINATE. SEPARATE RAW MEAT, POULTRY, AND 
SEAFOOD FROM OTHER FOOD IN THE GROCERY CART.
	- STORE RAW MEAT, POULTRY AND SEAFOOD ON THE BOTTOM SHELF 
OF THE REFRIGERATOR SO JUICES CANNOT CONTAMINATE OTHER FOODS.
	- USE A SEPARATE CUTTING BOARD, IF POSSIBLE, FOR RAW MEAT 
PRODUCTS.
	- NEVER PLACE COOKED FOOD ON A PLATE THAT PREVIOUSLY HELD 
RAW MEAT, POULTRY OR SEAFOOD.
	- COOK TO PROPER TEMPERATURE. USE A MEAT THERMOMETER TO 
MAKE SURE MEAT AND POULTRY ARE COOKED ALL THE WAY THROUGH. COOK 
EGGS UNTIL THE YOLK AND WHITE ARE FIRM, NOT RUNNY.
	- WHEN COOKING IN A MICROWAVE OVEN, MAKE SURE THERE ARE NO 
COLD SPOTS IN FOOD. COVER FOOD, STIR AND ROTATE FOR EVEN 
COOKING.
	- BRING SAUCES, SOUPS AND GRAVY TO A FULL BOIL WHEN 
REHEATING.
	- REFRIGERATE PROMPTLY. PICK UP REFRIGERATED AND FROZEN 
FOODS LAST AT THE GROCERY STORE.
	- REFRIGERATE OR FREEZE PERISHABLES, PREPARED FOOD AND 
LEFTOVERS WITHIN TWO HOURS.
	- NEVER DEFROST OR MARINATE FOOD ON THE KITCHEN COUNTER.
	- DON'T PACK THE REFRIGERATOR. COOL AIR MUST CIRCULATE TO 
KEEP FOOD SAFE.
	- DIVIDE LARGE QUANTITIES OF HOT FOODS INTO SEVERAL SMALL 
CONTAINERS BEFORE REFRIGERATING.
	AND LAST BUT NOT LEAST: WHEN IN DOUBT, THROW IT OUT.
	"IF YOU ARE UNSURE IF FOOD HAS BEEN PREPARED, SERVED OR 
STORED SAFELY, JUST THROW IT OUT. FOOD CAN LOOK AND SMELL FINE, 
BUT IT MAY NOT BE SAFE TO EAT," JONES SAID. "FOLLOWING SOUND 
FOOD SAFETY PROCEDURES WILL HELP TO PROTECT YOURSELF AND YOUR 
FAMILY FROM FOOD-BORNE ILLNESSES."
					-USN-

7.  COMMENTS AND IDEAS FOR MEDNEWS ARE WELCOME. STORY 
SUBMISSIONS ARE HIGHLY ENCOURAGED. CONTACT MEDNEWS EDITOR, AT 
EMAIL: MEDNEWS@US.MED.NAVY.MIL; TELEPHONE 202-762-3218, (DSN) 
762, OR FAX 202-762-3224.